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[Hirschsprung-associated enterocolitis: Observational study in a paediatric emergency care unit]
Margarita Sellers1, Clara Udaondo1, Bárbara Moreno1
1Servicio de Urgencias Pediátricas, Hospital Infantil Universitario La Paz, Madrid, España.
Insights
Hirschsprung-associated enterocolitis (HAEC) diagnosis in infants with Hirschsprung's disease is challenging due to vague symptoms. Lethargy, abdominal distension, and X-ray findings are key indicators for prompt HAEC diagnosis and management in emergency departments.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Surgery
- Pediatric Emergency Medicine
Background:
- Hirschsprung-associated enterocolitis (HAEC) is a severe complication of Hirschsprung's disease, leading to significant infant morbidity and mortality.
- Variable and non-specific symptoms of HAEC often delay or complicate diagnosis.
- Early identification and management of HAEC are crucial for improving patient outcomes.
Purpose of the Study:
- To identify clinical factors associated with HAEC diagnosis in children presenting to a pediatric emergency department.
- To evaluate the management strategies for suspected HAEC in this setting.
Main Methods:
- Retrospective descriptive study of patients with Hirschsprung's disease and enterocolitis symptoms.
- Inclusion criteria: pediatric emergency department visits between April 2011 and November 2015.
- Analytical multivariate analysis of epidemiological and clinical variables.
Main Results:
- 75 consultation episodes were analyzed; 52% were diagnosed with HAEC.
- Diarrhea was the most common presenting symptom (74.7%).
- Lethargy, abdominal distension, and abnormal X-ray findings were significantly associated with HAEC diagnosis. Hospital admission rate was 77.3%.
Conclusions:
- HAEC must be considered in all infants with Hirschsprung's disease presenting to the emergency department, particularly those with gastrointestinal symptoms, lethargy, abdominal distension, and radiographic abnormalities.
- Prompt initiation of diagnostic and therapeutic processes, including clinical observation or medical treatment, is recommended for suspected HAEC.
Introduction:
Hirschsprung-associated enterocolitis is a significant cause of morbidity and mortality in infants with Hirschsprung's disease. The fact that the symptoms are so variable and unspecific leads to a slow or incorrect diagnosis. The purpose of this study is to identify clinical factors associated with the diagnosis, as well as to evaluate the subsequent management of children with suspected Hirschsprung-associated enterocolitis in a paediatric emergency department.
Material And Methods:
A retrospective descriptive study was conducted on patients with Hirschsprung's disease who were seen in a paediatric emergency department between April 2011 and November 2015 due to clinical symptoms compatible with enterocolitis. An analytical multivariate analysis was also performed on the epidemiological and clinical variables associated to enterocolitis.
Results:
A total of 75 consultation episodes in the Paediatric Emergency Department were studied, of which 52% (39) were finally diagnosed as enterocolitis. Overall, diarrhoea was the most frequent reason for consultation (74.7%). Lethargy, abdominal distension, and pathological findings on the X-ray showed a significant association with the diagnosis of Hirschsprung-associated enterocolitis. Hospital admission rate was 77.3%.
Conclusion:
Hirschsprung-associated enterocolitis should be considered in all children with Hirschsprung's disease that consult the Emergency Department, especially those with gastrointestinal symptoms associated with lethargy, abdominal distension and pathological findings on the X-ray. The therapeutic diagnostic process should be initiated as soon as possible, either by clinical observation, if there are any doubts, or by medical treatment if there is a high clinical suspicion.
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